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0 0 <br /> UTILITY PERMIT APPLICATION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> 425-257-8810 - FAX 425-257-8857 —www.everettwa.org <br /> J56 S— <br /> 1tt a& 4 mla w <br /> "T' <br /> PROJECT ADDRESS (� <br /> "I LI Lknq elzie <br /> Property Owner Mail Address City State/Zip hone <br /> )jn <br /> Tenant Name(If this is for a commercial business) <br /> Contractor Mail Address City State/Zip hone <br /> Aa� te- a&�"ble <br /> WA State Contractor License (required) City of Ev ett Business License Number(required) <br /> Work to be done: <br /> ❑ Side Sewer Repair <br /> ❑ Side Sewer Alteration <br /> ❑ Side Sewer — New Installation <br /> ❑ Install Backwater Valve (outside the building) <br /> 111 Cap off Sewer <br /> ❑ Install Water Meter <br /> FEE <br /> • t V <br /> -� PERMIT# <br /> Signature Date UJ004 <br /> REVISED 11/19/2014 <br />